When asked what a typical workday entails, Joana Yinpaab Duubon describes what sounds like several different jobs rolled into one. Yet she tackles them all with impressive efficiency.
As the Ghana Health Service’s (GHS) Training/Project Coordinator for the Bono East Region, Joana’s role is multifaceted. She coordinates health care provider trainings, mentors and manages staff, offers technical guidance for health personnel, advises on patient screening procedures, coordinates establishment of “pregnancy schools”, facilitates meetings, and much more.
By leveraging her diverse skills, Joana has played a central role in the Integrated Antenatal Care (ANC) project, a collaboration between PATH and the GHS that’s improving how maternal infections are diagnosed and managed during pregnancy.
In Ghana, 2,700 women die of pregnancy and childbirth-related causes each year, and more than 20,000 babies die in the first month of life.
To address these critical challenges of infant and maternal mortality, the GHS and PATH have expanded infectious disease screening and treatment among pregnant women during antenatal visits. This includes testing for conditions like hepatitis B, urinary tract infections, group B streptococcus, and sexually transmitted infections.
Between November 2022 to March 2024, the GHS and PATH worked across five districts in Ghana’s Bono East Region to build the capacities of health care providers, improve availability of services through antenatal care, and strengthen linkages between primary and referral facilities.
With a background in nutrition, public health, project management, and more than 15 years of progressive experience working in maternal and child health, Joana Yinpaab Duubon is the GHS Regional Training/Project Coordinator for Bono East. Photo: PATH
“Treat the mother, and it helps the baby”
“[Maternal and child health is] an area I have so much interest and passion in,” Joana says. “Any health issue that destabilizes pregnant women and their children is of concern to me. The integrated ANC approach prevents infections for better outcomes and helps to prevent premature deliveries and stillbirths.”
Joana works closely with her supervisor, Dr. Paulina Clara Appiah, GHS Deputy Director of Public Health for the Bono East Region. Dr. Appiah monitors and evaluates program implementation across health areas, including noncommunicable diseases and maternal and child health and nutrition. Along with the PATH team, Dr. Appiah and Joana have ensured the smooth operation of integrated ANC services at nearly 70 facilities in Bono East.
"Treat the mother, and it helps the baby," Dr. Appiah says, recalling a previous project aimed at helping newborns unable to breathe or cry at birth. She knew many infant health issues like this could be prevented altogether through early screening and treatment of mothers during pregnancy.
To that end, the Integrated ANC project has made it easier for health workers to test pregnant women for infections during ANC visits, streamlined how clients get referred to other facilities, and provided health care workers, pregnant women, and communities with information on maternal infections.
The project has trained nearly 700 providers on improved screening and management of maternal infections and screened more than 24,000 pregnant women.
A public health physician specialist with training in tropical pediatrics, Dr. Paulina Clara Appiah, Deputy Director of Public Health for Bono East, has worked in various capacities at the GHS for 25 years. Photo: PATH
New tools, better outcomes
The Integrated ANC project builds on a partnership between PATH and GHS that goes back at least two decades. Dr. George Amofah, now a technical advisor with PATH, has worked with GHS throughout his career.
“It was easy to introduce new ideas with the Bono East Region staff,” Dr. Amofah says. Not only were staff enthusiastic about the integrated ANC approach, they also played a critical role in improving an ANC data collection mobile app, through what Dr. Amofah calls, “a process of ongoing co-creation.” The app provides real-time data monitoring, enabling the team to track progress across facilities and address issues more quickly.
When asked to highlight the most important elements of the project, Dr. Appiah, Joana, and Dr. Amofah all agree: improved point-of-care diagnostics have made a major impact on infection diagnosis and treatment. In the past, sending out samples and obtaining lab results took several days. Now, improved testing and lab capacities allow providers to screen and treat during ANC visits, saving pregnant women time and money. While some of the new diagnostics are more expensive for the health system, Dr. Appiah maintains, “the benefits outweigh the costs,” and the GHS has committed to continuing their use.
Community engagement key to impact
Providing enhanced health services is essential, but successful implementation hinges on community engagement. The project team led outreach including forums and radio campaigns and developed resources including behavior change materials to educate communities on maternal infections.
These activities have reached more than 2,000 community leaders and nearly 790,000 community members. Joana highlights the importance of involving stakeholders at all levels: “You can't handle ANC issues and outcomes alone at the health facility. You need to collaborate with local stakeholders and leaders right from the ground.”
Dr. Amofah also emphasized the importance of local outreach, particularly through pregnancy schools, where participants learn about infection prevention and how to have a healthy pregnancy. Many clients are joined by family members, including partners, mothers, or in-laws—those who support women during their pregnancy and beyond.
“While the idea is not novel, it’s about implementation” Dr. Amofah explains. These schools are not a new concept in Ghana, but only a few existed before the project. Now there are nearly 40 pregnancy schools across Bono East, where 365 health education sessions have been conducted, reaching more than 8,000 pregnant women and 2,000 family members.
PATH Technical Advisor Dr. George Amofah (2nd from right) meets with GHS Bono East staff to discuss the Integrated ANC project’s progress. He has worked with the GHS in various capacities throughout his 40-year career. Photo: PATH
Looking ahead
As the project concludes, PATH and the GHS are working to ensure sustained impact through these ANC interventions—not only to prevent maternal and neonatal deaths in Ghana but also to provide a replicable model for other countries looking to improve ANC.
The GHS plans to continue the integrated ANC approach on a long-term basis in Bono East, as many of the interventions are now fully integrated in the services offered to women. The Ministry of Health has also discussed national scale-up of services based on their demonstrated feasibility and acceptability through the project. PATH and the GHS are currently developing a roadmap to scale across Ghana.
Health worker training materials have also been adapted into eLearning modules that will be offered on the GHS eLearning platform. This will serve as an important project legacy to help ensure that the capacity-building efforts will continue.
